'We are in crisis': Personal support workers are the backbone of home care in Ontario — and there aren't enough of them

Richard Martin slurs when he speaks. He has difficultly walking and swallowing food. He has short-term memory loss, and dementia is inevitable.

Martin has Huntington’s disease, a neurodegenerative disorder. Until he was diagnosed in 2010, Martin had a busy east-end medical practice. Today, he is cared for by his wife, Melanie Dea, in their Rockland home.

Dea has watched the disease attack her husband’s mind and body. He needs constant attention and there’s only so much Dea can provide.

And that’s a problem. Because even though Martin is entitled to five hours and 15 minutes of home care every week, provided by a personal support worker, help is hard to find in rural Ontario and many other parts of the province.

Home care has been touted as a way to keep people out of hospitals and long-term care. It costs less than institutional care, it’s better for patients and a life-saver for beleaguered caregivers like Dea. She relies on it, but her experience has been that her husband’s entitlement does not translate into reality. Sometimes he will get the hours he is entitled to, but more often it will be only an hour or two, she says.

“There are so many PSWs who start and then they quit. Or they call in sick. I really need the break. I’m burned out,” says Dea. “It’s a full-time job. I get three hours of respite a week. What do I do? I go to the bank, to the grocery store.”

Across Ontario, home care agencies are struggling to recruit and and retain personal support workers, known as PSWs. They get jobs right out of school, but many soon leave the field after they discover that the hours can be inconsistent, they are paid a dollar or two above minimum wage and they have to rush between appointments.

“We are in crisis across the province,” says Miranda Ferrier, president of the 33,000-member Ontario Personal Support Workers Association. “We have families calling us, desperate for a PSW.”

A survey of the associations’ members about four months ago drew more than 13,400 responses. It found that 79 per cent were unhappy with their jobs. Almost 39 per cent said their reason for dissatisfaction was staffing issues, while 26 per cent cited the pay scale, 24 per cent said it was an unsafe work environment and 11 per cent cited long or unpredictable hours.

About a third of the respondents reported that they had already left the field. Almost two-thirds said they were burned out, 21 per cent said the job didn’t pay enough and five per cent said they had been injured.

“I hate to say it, but it’s not an attractive job right now,” says Ferrier.

PSWs are even harder to recruit and retain in rural areas, where they have to travel long distances between assignments. “The wear-and-tear on vehicles is immense. And who wants to travel for 45 minutes for a one-hour shift?” says Ferrier.

Chantale LeClerc, CEO of the Champlain Local Health Integration Network (LHIN), which covers Ottawa and much of Eastern Ontario, says the situation is serious.

The LHIN is seeing the impact of a job market where supply doesn’t meet demand. For much of 2015 and 2016, it took less than 10 days on average for a client to receive a first home visit. That increased to an average of 77 days by June 2017, before dropping as the result of an infusion of new funding from the province. But wait times for service is on its way up again. Clients waited an average of 28 days for service this May.

The LHIN’s wait list peaked at just more than 3,000 clients in early 2017. The list was whittled down last summer and into early fall last year because of the new funding, says LeClerc. But the wait lists started to grow again because the availability of workers could not keep pace with the demand.

It’s a complex issue, she says. PSW work can be challenging, and it’s a mobile workforce that goes where working conditions or pay are better. There are issues around how people are deployed. Clients want workers in the morning and evening to coincide with getting up and going to bed, but workers don’t want split shifts.

“We have the funds available to serve patients, we have patients who need the services, but we don’t have the human resources. In the past it was the funding. Now it’s the human resources. It means people are waiting longer.”

Home care workers are the bottom of the PSW hierarchy. While hospital PSWs can earn $26 an hour, those who work in home care earn only a little over $16, says Ashley Brewster, a PSW in Prescott.

Home care PSWs might expect consistent work, but find their hours shrinking unexpectedly if a client is hospitalized or dies, she says. They pay high gas prices and get low mileage compensation. And they face potential violence from clients.

“In home care, sometimes you don’t know what you are walking into,” Brewster says. “In the end, we have a very hard job. It’s hard on our bodies. It’s hard on our minds.”

Personal support workers say the time they have to spend with clients during home visits was scaled back following a much-hyped 2016 provincial pay raise.

Sue VanderBent, CEO of Home Care Ontario, which represents providers of home care services across the province, began to notice the shortage of PSWs late last fall. She has seen increased anxiety and less satisfaction among PSWs as they see their days being chopped up into 15-minute segments.

While there have been frequent announcements of new money for home care — last October, the province announced that it would fund 1.5 million additional hours of personal support service — home care has remained about five per cent of the total health care budget for the past 20 years, VanderBent says.

“Even though we have seen investments, what’s really happening is that it has kept pace with the growth of the whole system. We really haven’t compensated for the demographic growth of the seniors population,” she says.

“We have created a situation where families get very tired and desperate. People are at the end of their ropes.”

Last October, Dea sought a few hours of respite care while she went to Montreal. Friends had agreed to stay with Martin for the first few hours, and were to be relieved by a pre-arranged respite worker. Dea checked the night before and was assured the worker would be there. But the worker never arrived, and Dea didn’t know until she got a panicked call. Her vulnerable husband would be left alone in the house for two hours until she could get back from Montreal.

Dea was furious and wanted answers. “All I got was ‘I’m sorry’,” she says.

“If there is a shortage and a high demand, we have to see what we can do to get people into the field and stay in the field. If it’s a problem with the pay grade, then that needs to be fixed.”

The Ministry of Health and Long-Term Care is aware of the concerns and is working with LHINs, employers and other sector partners, says a ministry spokesman. “Ontario’s new government will be determining how to proceed now that it has been sworn in.”

Meanwhile, all of the players are working on solving the problem from different angles.

PSWs are an unregulated profession, but they must be certified through an education program. Community colleges, private colleges and even school boards offer the program.

Julie Rivers, director of the PSW program at Loyalist College, says the college has just opened up to a second cohort of students. The program now has two groups of graduates every year, one that takes the traditional eight-month program and another that takes a compressed six-month program, which had 44 graduates this spring. Loyalist also offers programs in smaller rural communities such as Bancroft, Napanee and Barry’s Bay.

“They are scooped up before they even finish their program,” says Rivers.

Stephanie Lee, coordinator of the PSW program at the Perth campus of Algonquin College, says graduates prefer to work for a public-sector institution such as a hospital or a municipal nursing home because the pay is better, and there is more likelihood they will get consistent hours.

This year she had 19 graduates, and they all had a job offer. Many students work as a PSW and use it as a launching pad for further education as a paramedic, registered practical nurse or other profession.

In the last provincial election, all three parties discussed the need for more money for home care. But none addressed the need to recruit and retain PSWs, says Lee.

“That’s great. But how are we going to staff what we have now if we are not funding people to do this work? You can’t just hire anyone. You have to hire the right people and make sure they’re learning the right skills.”

The Champlain LHIN is working with providers to look at different ways to schedule PSWs, and ways to assign them to a territory so they don’t have to cover as much geographic area. And it’s also looking at fast-tracking other health-care workers, such as paramedics and physiotherapy assistants into PSW roles without having to take the certification course, says LeClerc. The LHIN is also probing why some students graduate from PSW programs, then don’t enter the field.

“Part of the challenge is that there are potential causes and hypotheses, but little hard data. We know we need a range of solutions. There may be some we have not thought of,” says LeClerc.

Home Care Ontario will be launching a campaign to attract not just young people new to the workforce, but also people contemplating a mid-life career shift. Offering classes in high school, so high school graduates will have some of the skills they need to do the job, is one option, says VanderBent.

“People want to do a good job. It has to be a fulfilling job,” she says. “We have created a system where it’s not what it used to be. We have to bring that back.”

Some people who work in the field for 20 or 30 years are never dissatisfied, says Rivers. She believes that helping workers find the intrinsic value in what they do may be one of the keys to retaining workers.

“If you don’t get some intrinsic value from the work, then you won’t last long. Anyone who gets value out of the work will stay for a very long time.”

In 2014, a team of business researchers at McMaster University looked at “task shifting,” the delegating of certain tasks from regulated professionals to unregulated workers as a possible way to keep PSWs interested in their work.

One of the buzzwords in the business right now, for example, is “virtual wards,” a concept developed in the UK which uses the staffing of a hospital ward, without the actual building. PSWs would be the eyes and ears of a nurse, who would be connected remotely.

The McMaster researchers surveyed 46 home care workers about task shifting, including 20 PSWs. They found that half of the respondents thought task shifting would increase their intention to stay with the job. Learning new skills would increase their satisfaction with the job, and make them feel more accomplished, the workers reported. About a quarter said the opposite — task shifting would contribute to their intention to leave the home care sector because the new tasks would not be reflected in their pay, or the tasks would make them feel uncomfortable.

Ferrier believes the PSW shortage can be eased by making it a regulated profession. “I think it would change the entire dynamic of the profession. It would bring us the recognition we deserve.”

Incentives such as better pay, more money for vehicle maintenance or free scrubs might also help, she says. “There are all kinds of different things at play. But they will have to come up with something quick.”

By the numbers:

83,000: Number of personal support workers practising in Ontario

28,000: Number who work in the home and community sector

180,000: Number of clients in Ontario who receive personal support services at home

13,427: Number of PSWs who responded to a survey conducted by the Ontario Personal Support Workers Association

33 per cent: Proportion of these who said they quit in the past year

63.3 per cent: Proportion who cited burnout as the reason

22 per cent: Proportion of survey respondents who said they are considering leaving the field

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